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Transcript
John E. Vogan, MS-HSA, RN CNOR
Clinical Specialist
Memorial Regional Hospital
Cardiac and Vascular Institute
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Pleural Effusion Evaluation and Management
Abdominal Aortic Aneurysm
Atrial Fibrillation: Maze Procedure
Cardiovascular Complications
Valvular Heart Disease
Emerging Therapies in Atrial Fibrillation
Optimal Non-Invasive Therapy in CAD
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Focus : Cardiac Catheterization Lab
Luis Tami, MD- Global vascular interventional
concept
William Alexis, MD (moderator): “The Basics”
Juan Pastor, MD (moderator): “Adjunct
Therapies”
Brenda Sanzobrino, MD (moderator): “Clinical
Syndromes”
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Panel: Film Discussion
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Luis Tami, MD (moderator)
William Alexis, MD
Bassel Ibrahim, MD
Michael Marek, MD
Juan Pastor-Cervantes, MD
Brenda Sanzobrino, MD
David Gomolin, MD
Keynote Lecture: Acute Myocardial Infarction
David Gomolin, MD, Beth Israel Deaconess Medical Center
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MD from McGill University Faculty of Medicine, 1979
Internship/Residency
Royal Victoria Hospital in Internal Medicine, 1982
Fellowship
Beth Israel Deaconess Medical Center in Cardiology, 1984
Board Certification:
American Board Internal Medicine
Royal College of Physicians and Surgeons Canada
American Board Internal Medicine (Sub: Cardiovascular Disease)
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Cardiovascular disease (2006)
High blood pressure — 73,600,000.
Coronary heart disease — 16,800,000.
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Myocardial infarction — 7,900,000.
Angina pectoris — 9,800,000.
Stroke — 6,500,000.
Heart Failure — 5,700,000
http://www.americanheart.org/presenter.jhtml?identifier=4478
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Claimed 864,480 lives in 2005 (final mortality) (35.3 percent
of all deaths or 1 of every 2.8 deaths).
Other final 2005 mortality: total cancer 559,312; accidents
117,809; HIV (AIDS) 12,543.
Nearly 151,000 Americans killed by CVD in 2005 were
under age 65.
2005 final death rates from CVD were 324.7 for white males
and 438.4 for black males; for white females 230.4 and for
black females 319.7. (Death rates are per 100,000 population.
The rates listed use the year 2000 standard U.S. population
as the base for age adjustment.)
From 1995 to 2005, death rates from CVD declined 26.4
percent.
In the same 10-year period the actual number of
deaths declined 9.6 percent.
http://www.americanheart.org/presenter.jhtml?identifier=4478
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Coronary Artery Bypass
First performed May 2, 1960
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Robert Goetz, MD, Michael Rohman, MD, Jordan
Haller, MD, Ronald Lee, MD.
Autopsy 9 month later showed atheromatous
plaque at the origin of the LIMA
http://en.wikipedia.org/wiki/Coronary_artery_bypass_surgery#History
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Dr Vasilii Kolesov (1964): performs the first
successful coronary artery anastamosis
Dr. Rene Favalaro (1967): Cleveland Clinic
Foundation , Cleveland Ohio
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SVG to replace stenotic segment of RCA
SVG utilized as by-pass graft -RCA
Dr. Dudly Johnson: SVG to LAD, Cx
Drs. Charles Bailey, T. Hirose, G. Green: IMA
as conduit
http://en.wikipedia.org/wiki/Coronary_artery_bypass_surgery#History
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Dr. Mason Sones (1964) discovers the heart
tolerates intra coronary injections of contrast.
Thus the beginning of angiography
Dr. Andreas Gruentzig (1975) Zurich,
Switzerland,
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Invented double-lumen catheter fitted with PVC
balloon
(1977) First successful PTCA
http://en.wikipedia.org/wiki/Coronary_artery_bypass_surgery#History
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1980- 1000 angioplasties worldwide
1982- Over-the-wire co-axial balloon systems,
brachial guiding catheters, steerable guides
1986- Athrectomy devices
(Toulose, France) Dr. Jacques Puel & Ulrich
Sigwart implant the first “wall-stent”
http://en.wikipedia.org/wiki/Coronary_artery_bypass_surgery#History
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1987-1993 Technology boom
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Laser
Rotational atherectomy
IVUS
Stents
1994 – 1997
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Stents become commonplace
(1997) 1,000,000 angioplasties worldwide
http://en.wikipedia.org/wiki/Coronary_artery_bypass_surgery#History
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2003- First Drug Eluting Stent “Cypher” (J & J
/Cordis)
2004- ‘Taxus” (Boston Scientific)
2008- “Endeavor” (Medtronic)
http://en.wikipedia.org/wiki/Coronary_artery_bypass_surgery#History
http://www.ptca.org/images/endeavor_stent_vertical.jpg
http://www.cypherstent.com/Pages/index.aspx
http://www.bostonscientific.com/procedure/ProcedureLanding.bsci/,,/navRelId/1000.1002/method/Procedure/i
d/10001151/seo.serve
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Better drugs
Smaller stents
Absorbable stents
Drug coated balloons
Hybrid OR-Labs
Lesser invasive surgical approach
http://www.cathlabdigest.com/article/7265
http://www.spectrum.ieee.org/images/public_html/
automaton/DaVinci-Robot.jpg
http://www.dicardiology.net/node/30898/
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Best available evidence + clinical expertise
Robert Reich (1990) “public idea”
Dr. Archie Cochrane: “treatments that work”
Identify / End treatments that cause harm
“What is the best way to do this?”
“What evidence supports my reason?”
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“It is unethical to use treatment without known
efficacy”
Example:
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Vital signs q 15 min X 1 hour, q 30 min X 1 hour, q
hour X 4 hours
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U.S Unemployment rate: 10.7% (August 2009)
Detroit, MI : 17% (September 30, 2009)
Florida : 10.7% (Sept., 2009)
Broward County: 9.6% (Sept., 2009)
5.4% (Sept 2008)
http://www.bls.gov/web/laumstrk.htm
http://www.eflorida.com/profiles/CountyReport.asp?CountyID=6&Displ
ay=all
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Personal –vs- Employer Health Insurance
Guaranteed-issue personal health insurance
policies
Employer Pre-Tax Payment and
Reimbursement of Premiums
Employee Pre-Tax Payment of Premiums
through POP Plans
http://zanebenefits.com/blog/2009/10/183/What+Does+U.S.+Healthcare+Reform+Currently+Look+Like
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Computers
Technologically
EBP
Research
Flexibility / Change
Higher education
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CRM (1979) – NASA: Improve air safety
Majority of accidents result from Human Error
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Interpersonal communication
Leadership
Decision making
CRM Training
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Communications
Situational awareness
Problem solving
Decision making
Teamwork
http://en.wikipedia.org/wiki/Crew_Resource_Management
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…Change…
…the future will bring about much change, and
many challenges…
Cardiovascular Trends: Embrace the challenge